Kids Camp 2025

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STUDENT'S NAME* This field is required.
FIRST NAME
LAST NAME
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BIRTHDAY* This field is required.
DATE
Month
Day
Year
3
T-SHIRT SIZE
Kids Small
Kids Medium
Kids Large
Kids X-Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult 2XL
Adult 3XL
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GENDER* This field is required.
MALE
FEMALE
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GRADE AS OF 2023* This field is required.
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MOTHER/GUARDIAN* This field is required.
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FATHER/GUARDIAN* This field is required.
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MOTHER/GUARDIAN PHONE NUMBER* This field is required.
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FATHER/GUARDIAN PHONE NUMBER * This field is required.
10
HOME STREET ADDRESS* This field is required.
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STATE* This field is required.
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CITY* This field is required.
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ZIP CODE* This field is required.
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EMERGENCY CONTACT* This field is required.
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EMERGENCY CONTACT PHONE NUMBER* This field is required.
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STUDENT'S PHYSICIAN* This field is required.
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STUDENT'S PHYSICIAN PHONE* This field is required.
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INSURANCE COMANY* This field is required.
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POLICY #* This field is required.
20
DOES THE STUDENT HAVE ALLERGIES?* This field is required.
YES
NO
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IF YES TO ALLERGIES, PLEASE EXPLAIN OR TYPE NONE* This field is required.
22
IS THE STUDENT UP TO DATE ON THEIR TETANUS TOXOID IMMUNIZATION?* This field is required.
YES
NO
23
CAN THE NURSE GIVE YOUR STUDENT TYLENOL?* This field is required.
YES
NO
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IF NO, WHAT IS THE ALTERNATIVE?* This field is required.
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CAN THE NURSE GIVE YOUR STUDENT BENADRYL?* This field is required.
YES
NO
26
IF NO, WHAT IS THE ALTERNATIVE?* This field is required.
27
CAN THE NURSE GIVE YOUR STUDENT IBUPROFEN?* This field is required.
YES
NO
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IF NO, WHAT IS THE ALTERNATIVE?* This field is required.
29
CAMPER MAY BE GIVEN OVER THE COUNTER, NON-PRESCRIPTION MEDICATIONS OR APPLICATIONS, NOT TO EXCEED THE RECOMMENDED DOSAGE FOR STOMACH DISCOMFORT, BURNS, CUTS, INSECT BITES, RASH OR SCRAPE.* This field is required.Current Medications Camper is taking : (Please remember that medications HAVE to come to camp in their ORIGINAL CONTAINER. (This includes: over the counter medications, inhalers, and vitamins)
YESNO
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LIST MEDICATION NAME, DOSAGE, REASON FOR PRESCRIPTION, TIME OF DAY TAKEN/SPECIAL INSTRUCTIONS.* This field is required.
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PLEASE LIST ANY ADDITIONAL MEDICAL/HEALTH NEEDS YOUR CHILD MAY HAVE ARISE DURING THEIR TIME AT CAMP* This field is required.
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MEDICAL CONSENT:
I blank * GRANT PERMISSION FOR THE ABUNDANT LIFE KIDS CAMP NURSE TO GIVE MT CHILD (NAME LISTED ABOVE) THE MEDICATIONS LISTED ABOVE DURING THEIR TIME AT ABUNDANT LIFE KIDS CAMP.
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DATE* This field is required.
Month
Day
Year
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I First Name * Last Name * HEREBY GRANT PERMISSION FOR MY CHILD, NAMED ABOVE TO ATTEND THE ABUNDANT LIFE KIDS CAMP. I FURTHER RELEASE MY CHILD INTO THE CUSTODY OF THE ADULTS FROM OUR CHURCH WHO ARE ATTENDING KIDS CAMP. FURTHERMORE, I GRANT PERMISSION TO THE NURSE SELECTED BY THE CAMP DIRECTOR TO HOSPITALIZE AND SECURE PROPER TREATMENT (INCLUDING SURGERY) FOR MY CHILD. IT IS UNDERSTOOD THAT THE CAMP LEADERSHIP WILL MAKE CONSCIENTIOUS EFFORT TO LOCATE ME OR THE EMERGENCY CONTACT LISTED ON THIS FORM. I WILL FULLY PAY FOR AL MEDICAL EXPENSES, NOT COVERED BY THE CHILD'S INSURANCE. I UNDERSTAND THAT ABUNDANT LIFE CHURCH IS NOT RESPONSIBLE FOR MY CHILD ON ROUTE TO AND FROM ABUNDANT LIFE KIDS CAMP. I ALSO UNDERSTAND THAT PARTICIPANTS AT ABUNDANT LIFE KIDS CAMP ARE LIABLE FOR DAMAGES CAUSED INTENTIONALLY OR MALICIOUSLY. DAMAGE CAUSED BY A PARTICIPANT WILL BE BILLED DIRECTLY TO THE PARTICIPANT RESPONSIBLE AND THEIR LEGAL GUARDIAN. I UNDERSTAND THAT KIDS CAMP IS A VOLUNTARY ACTIVITY. CAMPERS MUST BE WILLING TO COOPERATE WITH THE OVERALL SPIRIT AND SCHEDULE OF THE CAMP. WE RESERvE THE RIGHT TO SEARCH PERSONAL BELONGINGS FOR SUSPECTED CONTRABAND FOR THE SAFETY AND PROTECTION OF ALL.
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PARENT/GUARDIAN SIGNATURE* This field is required.
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MY STUDENTS PHOTO MAY BE USED FOR PROMOTIONAL MATERIAL AND SOCIAL MEDIA
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DATE* This field is required.
Month
Day
Year
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I First Name * Last Name * HAVE REVIEWED THE CAMP INFORMATION AND THE CONSENT FORM. CAMPER'S SIGNATURE BELOW CONFIRMS HIS/HER AGREEMENT TO ABIDE BY CAMP POLICIES INCLUDING DRESS CODE.
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STUDENT SIGNATURE* This field is required.
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DATE* This field is required.
Month
Day
Year
Should be Empty: